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While Hans-Jiirgen Gocrtz is not the first scholar to scc anticlcricalisn~ (resistance to, even hatred of, a corrupt religious clergy) as a motivating factor in the Reformation of the sixteenth century, he certainly has written more on the subject than anyone else. In this volume Gocrtz shows how anticlcricalism manifested itself among the clergy who broke with Roman Catholicism, among nobles like Ulrich von Hutten, among peasants, artists and cartoonists, and among the Anabaptists.

Astruc first noticed the latter in a fleet, denominating the disease christallmesy and from the part on which they appeared considering them venereal. We suspect they are more common in civil life than is generally suspected.* All these diseases are attended more or less with fever, and, if neglected, or the patient is deprived of wholesome diet and air, frequently end in sordid ulcers or gangrene. The description given by Mr. Wood is very correct in all these points. We shall transcribe only the following as connected with an important question in medical jurisprudence. The reader will, perhaps, urge, that,, in this instance, the patient was well in 'her general health until the local symptoms were manifest. But we must always make large allowance for the rank in life of our patient. The early or slighter complaints in the children of poor manufacturers in Manchester are very likely to be overlooked by the parents and even by the children as soon as they are old enough to be constantly employed in earning their daily bread. No wonder, therefore, if the child's indisposition attracted no notice * Sec an ingenious paper by JNIr. Royston in our Vol. xxiii. p, 241. 2 kill Medico-Chirurgical Transactions, 483 till the local symptoms were so violent as to make her complain.
" ? Jane Hampson*, aged four, was admitted an out-patient of the (Manchester) Infirmary, Feb. 11,17<J]. The female organs ?were highly inflamed, sore and painful; and it was stated by the mother, that the child was as well as usual till the preceding day, when she complained of pain in making water. This induced the mother to examine the parts affected, when she was surprised to find the appearances above described. The child had slept two or three nights in the same bed with a boy fourteen years old; and had complaincd that morning of having been hurt by him in the night.
" 4 Leeches, and other external applications, together with appropriate internal remedies, were prescribed ; but the debility increased, and on the 20th of February the child died. The coroner's inquest was taken, previously to which the body was inspected, and the abdominal and thoracic viscera were found to have been free from disease. The circumstances above related having been proved to the satisfaction of the jury, and being corroborated by the opinion I gave, that the child's death was occaeioned by external violence, a verdict of murder was returned against the boy with whom she had slept. A warrant was therefore issued against the boy, but he had absconded, a circumstance which was considered as a confirmation of his guilt, when added to the circumstantial evidence alleged against him. u By the use of these means, the enlargement of the parts gradually subsided, the foul bottom of the sores became red, after ?which the ointment of white lead was used, and the parts healed T)y the 14th of February, a space of seventeen days from the first attendance. " In this case the affection again returned, but was early cured "by resorting to the same remedies. The patient frequently retained the urine twenty-four hours, the pain was so violent, and obstinately resisted every inclination to empty the bowels, so that the opening remedies were obliged to be exhibited with a regular attention. " Case II.?On the 25th of April, 1815, 1 saw Miss S. aged five years and a half. She had been unwell a few days previous to the 21st, when complaining of pain in voiding the urine, the parts Were examined and found slightly red ; they were washed with milk and water, and dusted with the lapis calaminaris. On the 22d, the inflammation had increased, and the parts were slightly cxcoriated.
On the 23d, a thick yellow discharge was observed, the patient was getting more unwell, the bowels were slow. On the 24th, the open surfaces were enlarging, and small watery vesicles appeared upon the labia and perineum ; upon the left thigh also was a large cluster; the bowels were twice opened this day by some family purgative. " On the 2oth, I saw the patient, and found both labia enlarged, and of a purple redness, with numerous small watery vesicles, upon the external surface, and also within the fissura magna. They were similar to cowpock vesicles of the third and fourth clay ; were found also upon the perineum, and the top of the left thigh. In some places the tops of the vesications were loosened, and showed beneath a deep foul ulcer, particularly in tho cluster mpoa the thigh, and on the anterior part of the labia. The parts v-" within Mt'dico-Chirurgical Transactions.
?within the fissura magna were every where red and inflamed, and several small ulcers were found. The skin around the anus was painful and red ; and the secretion was then copious and offensive.
There was a dull headache, a quick and irritable pulse, a moist tongue, but bearing a clay-coloured deposit; the motions on tha 24th, were dark-coloured and offensive ; the patient was considerably weakened, and the face of a peculiar paleness. I advised saturnine lotions slightly warmed, and saturnine poultices without oil, to the parts, and gave small doses of puiv. rhei in a saline mixture every three hours. " April 26.?Fresh vesications still appearing; and, when the tops of the earlier vesicles had come awa'y, the parts beneath wero deeply ulcerated. Several aphtha? were observed within the labia, upon the perineum, and around the anus. The skin was hot and dry; the bowels open, and motions dark and offensive; with excessive pain upon voiding the urine.
" 27-?The top is thrown off from the clustcr of vesicles upon the thigh, as well as from the vesications upon the pudendum and perineum ; the open surfaces are deep and foul, secreting largely a thin and offensive matter; the anus surrounded with aphtha:; tha pulse J20 ; skin hot and dry ; bowels open, and urine excessively hot and painful. Ordered a decoction of bark, with conf.. cardiaca; recommended a little red wine to the patient, and to continue the applications to the parts. a 28.?The bowels slow ; the urine has been retained thirtyhours; the abdomen tender and hard; with much difficulty she was prevailed upon to void the urine, which was copious, highcoloured, and of a strong smell: the aphtha?, had almost disappeared, and the diseased parts shewed a large ulcer of various depths, extending over the pudendum and perineum, down to the anus ; the parts within the labia were in the same state, and a deep ulcer, but not extensive, lay upon the left thigh, on its upper and inner part; the secretion is thin, copious, and offensive. Thesoros wera ordered to be washed with the lotion as usual, and dressed with the white lead ointment. Continue the bark mixture, and increase the wine. " 29th and 30th.?The ulcerations were stationary; the same means were continued; but, as the bowels were slow, they were moved with an infusion of senna. May 1.?Sores improving; the bottom becoming less foulr and discharge less offensive; pulse 90 and weak ; appetite poor; sits up a little ; great inclination to retain the urine; bowels open. Continue the applications and remedies. " 2d.?The sores improving, as well as the strength. This state of improvement continued regularly, till the sores were healed on the 14th.
After the healing, the pudendum continued discoloured and tender, and a considerable yellow mucous discharge continued with varying quantity for the space of six or eight weeks ; this wa3 relieved by a continued use of the tinct. lytta?, bathing the parts frequently in the day with a solution of tfeg sulphas zinci; the shower Critical Analysis, shower-bath was also used with the intention of chocking-the secretion, as well as getting np the strength. I saw* this patient on the 27th of June, when the discharge had ceased. " Upon looking over my notes, i find that, in nine years, I have seen twelve cases; of these, I have only seen the two above related so early as to he materially serviceable; the others, being among the children of labourers, had little chance, either from the attention or punctuality of the parents, of getting over so very formidable a disease. One, a little girl of two years old, recovered, and was attacked again in the course of a fortnight, which second attack proved fatal. In a girl, five years of age, where the earlier appearances of the disease had been entirely overlooked, the mother upon finding an extensive ulcer, brought the child to me, under the idea of its having received injury from fire, which had escaped attention. The case proved fatal." Thus, of twelve cases, ten were among the labouring poor. By what means these epidemics reach the rich, cannot al-.ways be ascertained, but probably the greater matter of surprise should be that it does not oftener occur. Among children, it is still more likely, as it is impossible to prevent nursery maids from introducing their little charges to their owl* relations, and even in infantile day-schools the gradations must sometimes intermix. Brodie, in the Philosophical Transactions for 1811, it was a generally received opinion, that animal temperature depended on the chemical changes which the blood undergoes in the round of circulation. On this supposition a beautiful and apparently satisfactory theory had been constructed. This much esteemed fabric of human reasoning has, however, received a severe shock from the experiments above alluded to, which tend to establish the following facts: that, when the brain has been destroyed, animal heat ceases to be generated, notwithstanding the functions of respiration arc artificially continued, and apparently all the chemical changes are produced in the lungs; and further, that an animal thus subjected to artificial respiration, cools more rapidly than one that is simply killed by decapitation, probably in consequence of the circulating blood being exposed to the cold stream of air which is introduced into the lungs. From these facts it appears that nervous influence is essential to the production of animal heat." Mr. Hunter has been often accused of reading little. If such was the case, ample revenge has been taken of him, as lie seems not to be read at ail. We have only mentioned the 487' the name of Hunter, because that name is in every surgeon's mouth?him they commemorate by an annual festival. In honor of him, a magnificent mausoleum has been erected, and lectures instituted, as if in imitation of those: athletic games by which the virtues and prowess of ancient'' heroes were celebrated. Did then " this much esteemed fabric of human reasoning receive no severe shock'*' from his observations? (we avoid the word experiments' for reasons which will presently appear.) Let us transcribe the following passage, published a second or third time only a year before his death. u This power of generating heat, seems to be a property in an animal while alive. In the most perfect animals it is to preserve a,. Standard heat; and as they are most commonly in an atmosphere colder than themselves, they have most commonly occasion to exert it; and it is therefore a power only of opposition and resistance ; for it is not found to exert itself spontaneously and unprovoked ; but must always be excited by the energy of some externa! frigorific agent, or disease; yet it is natural to such animals that this power should be called forth ; as will be observed by-and-by, It does not depend on the motion of the blood, as some have sup** posed, because it likewise belongs to animals who have no circulation : and the nose of a dog, which is always nearly of the same heat in all temperatures of the air, is well supplied with blood ; although we must allow, where this power is greatest, the circulation is the quickest: neither can it be said to depend upon the nervous' system; for it is found in animals that have no brain or nerves* However, it must be allowed, that all that class who possess this power in the highest degree, have the largest brain, although this power is not in the least in proportion to the quantity of brain in that class. Jt is most probable that it arises from some other principle; a principle so connected with life, that it can, and does, act independently of circulation, sensation, and volition; and is' that power which preserves and regulates the internal machine.
This power of generating heat, is in the highest perfection when the body is in health; and in many deviations from that state, wc find that its action is extremely uncertain and irregular; sometimes rising higher than the standard, and at other times falling mucil, below it. Instances of this we have in different diseases, and even., in the same disease, within very short intervals of time. Avery remarkable one fell under my own observation, in a gentleman who was seized with an apoplectic fit; and, while he lay insensible in bed, covered with blankets, I found that his whole body would, in an instant, become extremely coid in every part, continuing so for some time; and, as suddenly, would become extremely hot,' While this was going on alternately, there was no sensible altera, tion in his pulse for several hours. il Beins 483 Critical Analysis. tc Being satisfied of the foregoing fact, that animals had a power t>f generating heat, I pursued the subject still further; not so much with a view to account for animal heat, as to observe the different phenomena, with the variations or difference in the heat in different animals."* By the above passage it appears that Mr. Hunter proved, without the uncertainty of experiments, that animal heat does not depend " on chemical changes which the blood undergoes in the round of circulation ?'that it does not depend " on the nervous system:" but on that power which preserves and regulates the machine, and which is only influenced, not generated, by external circumstances, under health and disease. Consequently, that this great philosopher made his experiments, not with a view to account for animal heat, (for this would not have been less futile than the attempt to inquire into the principle of life,) but with a view to observe the different phenomena, with the variations of difference in different animals.
It is true, we are referred to an experiment [an expertvnentinn crucis~\, in which, after the brain was removed, respiration being kept up artificially, animal heat ceased to be generated. If, indeed, we could suppose, that the power which regulates the (i internal machine remains unimpaired," when the brain is destroyed, we might then say?? {{ The times have been, <c That when the brains were out the man would die, <c And there an end, but now they rise again Ci With twenty mortal murders on their crowns, tc And push us from our stools. This is more strange <c Than such a murder is." v It certainly would have been strange, if either the generation of heat, Or the secretions, had been regularly maintained, or reduceable to any laws in such a condition of what is called a warm-blooded animal; or, to use Mr. Hunter's more accurate expression, in an animal capable, under common circumstances, of preserving a standard heat.
Respecting Mr. Earle's paper, we ought to remark, that it contains many judicious observations. The result of some of his experiments surprised us ; but so many particulars are requisite in every experiment connected with the operations <?f a living animal, that we are not disposed to doubt his accuracy, though the result does not always accord with our own observations. This is only in a single instance ; most of * Animal Economy, page 103; edit. 179%, 480 the rest confirm a law established long since by Mr. Hunter, that, though, to the feeling, inflammation seems considerably to encrease the temperature of a part, yet, by experiment with the thermometer,the change never exceeds a very few decrees.
It is not difficult to account for this. We are accustomed to make our remarks on inanimate matter, which, at first raises or reduces our own temperature to its own ; but, in a little Avhile, the temperature of the two substances in contact is similar. Now, in touching a living body under fever, each part in contact maintains, as tar as possible, its own standard.
Hence, the encreased heat of the person under fever, is restored as fast as it is communicated to a person in health, and thus gives him the sensation of a much higher temperature.
We perceive Mr. Earle uses the term arterious for the adjective of artery. As far as we have had time to consider the subject, we suspect he is right; but we should be very thankful to learn his motive, as nothing evinces our improved philosophy more than a greater correctness of language.
(The other Articles in our next.) Treatise on Uterine Hemorrhage, By Duncan Ste wart, Physician-Accoucheur to the Westminster General Dispensary, and Lecturer on Midwifery, in London. 8vo, pp. 151.?T. and G. Underwood. Those only on whom such a task devolves can be aware of the difficulties which beset our critical department. In vain do we resolve to confine ourselves to simple analysis, in vain attempt, by mere extract, to show the spirit, tendency, and merits of a work. Even if our readers expected np more of us, we find it impossible to restrain our feelings, if not of admiration or disgust? at least of surprise ; and, of all the works which have ever appeared before us, we ard ready to acknowledge the latter sentiment has been the most strongly excited by this Treatise.
In the advertisement prefixed we are told-*u The object of the following Treatise is to point out a mode of treatment, which has been found very beneficial in alarming cases of uterine haemorrhage. " In the Introductory Observations, an attempt is made tp c*. plain the functions of the uterus, by (racing the resemblance which that organ has in its action to the other involuntary muscles; and the remarks on this subject will not, perhaps, be thought misplaced, when it is considered that many of the best-established, rules of practice in midwifery, have been the result of what is known of the structure and functions of the uterus. &o. 214.
3 R " Ia 4Q0 Critical Analysis. " In the mcdical treatment of uterine hemorrhage, I am no^ aware that opium is generally given, although it has been recommended by some foreign authors as highly beneficial. Doctor Jame? Hamilton, Professor of Midwifery in the University of Edinburgh, to whom I am happy in having this opportunity of expressing my obligations for his instructions, and my respect for him as a practitioner, has long recommended it as the best remedy for relieving the irritation and state of debility wliich are induced by this disease; and Mr. Burns, of Glasgow, has also mentioned it as useful in this complaint. But, in many of the best publications on midwifery, the use of opium in uterine haemorrhage is altogether condemned.
The cases detailed in the following Treatise will, I hope, remove the prejudices which theory may have advanced against the tisc of opium in uterine hajmorrhage, and establish the good effects to be derived fronl giving large doses of that medicine. " Golden-square; Aug. 1, 1816." Tt must appear strange that men who have devoted a long life to midwifery, in this immense metropolis, should have been so deficient as to leave the most important part ot the art to be elucidated b}' a gentleman recently arrived, among us: for, though that gentleman is already a teacher, yet, as his book is dated 1st August, as his name is not in the College List published the last day of September,, we must conceive either that he has arrived too recently to complete his examinations, or that he is under the age required by the College for a license. We take ho notice of the want of M.D. to his name, as all our readers know such a title: tnay be readily acquired, and almost at any age.
To return to the advertisement. Are none but foreign authors, and Dr. Hamilton of Edinburgh, and Mr. Burns of Glasgow, to be considered. Have no other writers given their opinion on opiates in these cases. If the author is " not aware that opium is generally given," would it not have been respectful to enquire of the London faculty what the usual practice is, or to have remarked that, after forty years bf extensive practice, the venerable Uenman had not indee^ condemned or shewn any prejudice against it, but, from the result of long experience, with becoming modesty, given it as his opinion, that, unless with A view of moderating some uncommon degree of pain, or quieting some tumult, he seldom used opiates in abortions, considering the recurrence of pain as, in some degree, necessary for thv proper con* traction of the uterus.
The introduction contains the usual doubts and arguments relative to the muscular properties of the uterus.
Among the reat, that there are other muscular parts in which we size and figure of the impregnated uterus. When the sphincter ani is relaxed, its fibres are elongated, and its substance rendered thinner. The uterus, as it enlarges its cavity, instead of losing its thickness, usually increases it.
The first section contains, " Observations on the practice .generally employed in Uterine Haemorrhage." In this, after a few remarks on the manner in which other vessels usually act under haemorrhage, the author proceeds?r u First, to point out wherein the plan of treatment, which has generally been recummcuded in uterine haemorrhage, fs defective; from any of us. u The vessels (says he) connecting the placenta to the uterus are very large, particularly the veins, which inosculate freely, aud 6re without valves," We are at a loss to conceive that the author can refer to vessels connecting the placenta with the uterus as very large, ?which have never yet been discovered, and into which the finest injections can never be forced ; yet his language seems to imply nothing less.
In considering the practice generally employed, Mr. S. proceeds? et Secondly; Whether, by puncturing the membranes before the os uteri is dilated, we can depend upon it as a certain immediate moans for suppressing the haemorrhage? " Thirdly; Whether, by puncturing the membranes before the 09 uteri is dilated, we do not often destroy the chance of savin" the child's, and sometimes even the mother's, life?" The author then proceeds to show that, if the liquor amnii* escapes before the os uteri is dilated, a protracted labour follows; that, if the uterus contracts on the body of the child, though the haemorrhage may cease, the delivery is likely to be protracted. " But, (says lie,) even granting that the uterus, by contracting, considerably diminishes the diameter of its vessels, as long as the child is alive, and still in the uterus, the foetal mode of life will be continued, and in this respect the functions of this organ will re. main unaltered : the quantity of blood circulating towards its vessels will, therefore, continue undiminished, their action will be necessarily increased, and the hemorrhage will continue unabated.
In this view of the subject, then, the evacuation of the liquor amni can be of little service in restraining uterine haemorrhage." u Many bad effects are said to arise from introducing the hand into the uterus; and some writers have even asserted, that to this cause may be traced many of the cases of cancer and phagedena of the uterus, which occur in advanced life. It is only, however, when the liquor amni has been evacuated, and the utprus has contracted firmly round the child's body, that intro. ducing the hand can injure it. For, if the os uteri be cautiously dilated whilst the membranes are entire, the introduction of the hand can produce no bad effect, as no pressure will be made by it ou any part of the uterus; and, when the child's feet are grasped and brought into the vagina, it will be turned with the greatest facility." &c.
We have made these long extracts to give the author fair treatment: and, if we had only to contend with a logician, we might be puzzled where to begin our answer, as it would be impossible for us to understand each other. The reader might, indeed, be amused, if words were all that are to be considered. But an infinitely more important duty awaits us.
Without, therefore, doing more than quote the author's words, we shall take the liberty to ask what writers, or what practitioners, he refers to, who assert that phagedena and cancer uteri, in advanced age, have been caused by introducing the hand during a parturition many years before? * We know not by what authority Mr. S. always writes liquor amni. We could enlarge our inquiries of this kind, if we had no greater objectipns tp his wprk.
"whe 494, Critical Analysis, who ever suspected these difficulties when the feet are brought'' into the vagina? or, lastly, who, under dangerous haemorrhage, would be satisfied with mere rupturing the membrane without instantly preparing to deliver by art?
The author proceeds to " some remarks on the practice generally recommended in uterine /Hemorrhagefrom detention of-the placenta.'" the uterus are incapable of separating it, it becomes necessary to introduce the hand to assist in effecting the separation. The practice generally recommended in these cases, is to insinuate the fingers between the placenta and the uterus, and to peel it off. But, by following this plan, whilst the separatiou will be attended with great pain, aud considerable risk of lacerating the internal surface of the uterus, the hasmorrhage will be iucreased, mor<f vessels being lacerated ; and the object of introducing the hand will be but imperfectly accomplished. When the placenta is converted into a cartilaginous or bony structure, it often adheres so intimately, that it will be impossible to tear it away without lacerating the uterus; and, when it is morbidly soft, by separating it in the method above mentioned, part will be left adhering to thV uterus, which will be attended either with immediate or fu^urg inconvenience.
*' Uterine hasmorrhage ^sometimes occurs after the placenta is .delivered, and then it generally arises from want of contraction iti the uterine fibre. In these cases, the long.continued application of cold has been generally advised ; and this practice has been car* ried to the extent of immersing the patient for hours in ice-cold water.
Cold, when applied suddenly,-has the effect of cxciling the uterine fibre to contract; but the long-continued application of it, if the clfectg on the general system are considered, cauuot be expected to excite the uterus to contraction, and must otherwise prove injurious. Plugging the vagina has likewise been recomr mended in those cases of the disease; but this plan must bo very dangerous,?for sometimes, when a coagulum ol blood fills up the os uteri, an accumulation of blood takes place within the uterus, .and the patient sinks from internal hemorrhage, although 110 blood appears externally. " From these remarks it will appear, that the plan generally recommended for treating those cases of uterine hemorrhage whi?h take 4f)6 Critical Analysis. take place after the delivery of the child, will admit of some modification." Those who have perceived, in the writings of the modest Denman, the slow progress of obstetric improvement till it fell into the hands of practical anatomists; who have after-Wards seen, in the same writer, the progressive advances it made during the practice of Sandys, Smellie, and W. Hunter; the manner in which they gladly improved by each others observations, and advanced by slow degrees! we will say no more, but regret that short popular treatises, in which plausible attempts are made to render decision on delicate points easy, should become so frequent. Nothing can be more desirable than to establish certain aphorisms in all intricate cases. These are taught, with as much perspicuity as the cases will admit, in printed works; and we have happily hitherto possessed a succession of teachers in the metropolis, with every clinical assistance which this important branch of medicine can admit.?Without, therefore, noticing the above, we shall only offer a few specimens of the author's practice.
.Respecting haemorrhage in the early period of pregnancy, we are told?" When abortion is attended with profuse haemorrhage, the discharge may easily be commanded by staffing the vagina." In the more advanced ktage of pregnane}7, stuffing is objected to, and speedy delivery advised, to assist which, four grains of solid opium and 100 drops of laudanum are said to be very useful. This is a large dose for a London lady ! Among the directions, we shall copy the following: " As soon as the child is expelled, the hand must be introduced into the uterus, and retained there, till that organ, by contracting, separates the placenta, and forccs it into the vagina." We say nothing of the evident impropriety of introducing the hand into the uterus, t: as soon as the child is expelled/' without waiting to discover whether such operation will be at all necessary. But, suppose, when the hand is introduced into the uterus, the operator perceives the flooding to bef increasing, and finds that the presence of his hand neither restrains it, nor makes the uterus contract, which is no uncommon occurrence, ought he not to proceed to detach the whole of the placenta, the partial separation of which is thecause of the flooding ? We have said enough to caution our younger readers against what we conceive a juvenile performance, the publication of which will, we trust, induce the College to renew their fprmer practice of examining licentiates in eudwifery | 3 antU Mr. Stewart ow Uterine Hemorrhage. 497 and, perhaps, they may add a few additional questions to teachers of that important art. The following case we offer as illustrating Mr. Stewart's practice.
" I was convinced, (says Mr. S.) from the whole circumstances attending the case, that the only chance of saving her life consisted in the speedy delivery of the child j but, before proceeding to accomplish this purpose, eighty drops of laudanum were given, which, after waiting twenty minutes, produced 110 sensible effect. Oue hundred and twenty drops more were therefore given, which, in ten minutes, were followed by drowsiness, with a remission of the vomiting and tremors. At eight o'clock, the hand was introduced into the vagina, the os uteri cautiously dilated, the placenta detached at one side, the membranes ruptured, and the child's feet grasped, and brought into the vagina. The vomiting and restlessness again recurring, eighty drops of laudanum were given, which produced composure, and a permanent cessation of the vomiting. The foetus, which appeared to be of the seventh month, was gradually extracted. The hand was introduced immediately afterwards, and the uterus contracted, separating the placenta, and forcing it into the vagina; from whence it was gradually removed.* It is easy to understand, by the above account, that the woman took '280 drops, rather more than half an ounce of laudanum, besides brandy and beef-tea, in the space of about an hour. That this may sometimes be sate, and even necessary, cannot be doubted ; but should it be offered, as a general rule ? As to the manipulation, the account i* somewhat more obscure.
Before we ventured to send the above to the press, we thought it right to consult a friend, who has been little short of forty years in practice, and who, from being one of the physicians of the most extensive Lying-in Charity in London, must have had a competent share of experience in the most difficult cases. From him, besides some of the above re-t marks, we learn that a preparation of equal parts of laudanum and dilute sulphuric acid, has been the remedy entrusted, with proper instructions, to the mid wives, for their use in cases of haiaiorrhage, perhaps from the first institu* tion of, the charity, but certainly for fifty years past. So that the use of opiates in uterine haemorrhage is not new. Our friend informs us that he seldom exhibits opium in haemorrhage, confining it almost entirely to such cases as are accompanied with irregular spasmodic contraction of the uterus, or with severe pain. His principal reason for abstaining from opium is one which Dr. Stuart uses in recommendation of it, viz. that it prevents tainting. Now, fainting our friend considers as .always a desirable event, being nature's remedy for stopping the discharge, and one thut No. 14.
" i) s never 493 Critical Analysis. never fails, except its efficacy be counteracted by brandy, wine, or other cordials, of which opium may be reckoned one; and, to insure this effect, Dr. Stewart very frequently unites brandy with it. To the enquiry, what remedies he puts most confidence in for restraining uterine haemorrhage? our friend mentioned two, in which, supposing the uterus to have been previously emptied of its contents, or that its evacuation Avas deemed improper, he nearly puts his sole confidence: these are, colcl water, not as applied externally, but' taken into the stomach ; and extreme quiet, avoiding, by every possible means, the rousing the powers of life ?which Dr. Stuart is so constantly attempting by the exhibition of brand}' and opium.
The College of Physicians have, in their list of licentiates, men of djstinquished abilities, and, for a series of years, confined to the obstetric art; and they could very lately exhibit the names of Denman, Combe, and Clarke, as licentiates in. midwifery. One of these still remains. Why then do they not establish a court of examiners, consisting of their president, Glided by such men. We are aware such a court cannot, with propriety, be formed from their own members, strictly so called, who by charter or bye-law are interdicted from chirurgical practice. The examiners of the Surgeons' Company are scarcely more competent, as none of them are practising accoucheurs. Thus, whilst a court is established lor the examination of apothecaries, surgeons, and physicians, the softer sex, under circumstances the most interesting in the animal creation, and in which two lives are at stake, are to be left at the mercy of those who chuse to undertake the cure of them, and even to teach others. JDr. Scudamore's researches are marked by a philosophical spirit. He has contrived to infuse a good deal o? interest into his pathological discussions. We are to look, says-he* botii in principle andjuactice, uot to ao midefinable and Dr. Scudamore on Gout. 499 and untangible something pervading the frame, but to the peculiar actions of the organs destined for secretion and excretion in connection with the state of the digestive functions: and it is to the disturbance or derangement of these last that every thing in the rationale of the disease in question is to be regarded as subordinate. His vievVs, indeed, of gout, are confessedly those of Mr. Abernethy, in reference to general deviations from health; and vve thihk he has carried his simplicity of doctrine to a verba.magistri extreme. We shall, ho wever, present our reader's with an analysis of the book, having, on former occasions, expressed our aver* sion to the modern affectation of composing original essays, partly extracted from the work which they pretend tp review.
Instead of Dr. Cullen's division into regular, atonic, retrocedent, and misplaced gout, Dr. S. proposes to divide the disease into acute," {e chronic" and " retrocedent" considering the acute form of the disease, without regard to particular situation, as the one species, the chronic as the other species, and the retrocedent as the variety. The following are his definitions of these states:? 500 Critical Analysis.
Causes; terminating almost invariably without suppuration, and usually with critical indications of the event. " Chronic Gout. Inflammation and pain more slight, irregular, and wandering, than in the acute ; faint redness of surface; much permanent distention of parts, or continued oedema, and impaired moving power; without critical indications of its terminating; associated with a morbid state of the digestive organs, a languid or oppressed circulation, and much nervous irritation in the system. <s Retrocedent Gout. Metastasis, or transference of the gouty action in the paroxysm, from the external part to some internal organ." When we allow that the above definitions are superior to those of Dr. Cullen, we must, at the same time, observe, that they are, in some measure, lengthened out into the shape of histories, and "have, therefore, this advantage over the more concise and more properly speaking definitions of the celebrated Edinburgh professor. Our author objects to Dr. Cullen's description of retrocedent gout, inasmuch as it assumes the internal affection which takes place upon the retrocession of the outward inflammatory action, to be necessarily and invariably atonic or spasmodic; whereas it is something as decidedly inflammatory as that external affection of which it has proved vicarious. This exception may, upon the whole, be regarded as a salutary caution, since it is of the highest moment, in reference to practice, to distinguish between gouty spasms and inflammation ; at the Same time, it must be admitted that metastasis in gout is most common in those feeble and debilitated subjects who are more frequently the subjects of spasmodic than inflammatory action. In rheumatism, on the contrary, metastasis seems sometimes to take place with a readiness and rapidity proportioned to the state of high excitement under which the individual is found at the time of the attack.
Dr. S. presents his readers with the following statement of seventy-one examples, under his own observation, of the parts affected in the first fit. This we transcribe for the benefit of the young practitioner.
In the great toe of one foot only, forty-nine cases. <c In the great toe of each foot, jour.
In the toe and instep, two. u In the outer side of one foot, two. " In one ankle, two.
" In eacji anlcle, one. u In the ankle and instep of one foot, one.
" In the toe, instep, and ankle, of one foot, one. " In the instep of each foot, one.

" In
Dr. Scudamore on Gout. 501 C? In the liccl of one foot, one.
" In each foot and hand, one.
" In one toe and thumb, one.
"In the right knee, one.
{ " In the left knee, one.
" In one hand at the back, one. <c In one wrist, one. " In each hand at the back, one.
<c From this statement, (says our author,) it appears (hat podagra, is too limited a term even to mark the first lit, as an appropriate designation." With regard to the " bodily conformation" of the subjects of athritic affections, Dr. S. tells us, that they are " for the most part formed with a capacious and circular chest; that thej^ have large full veins and loose solids." That the disease is more common to men than females every one is aware, " which must (says our author) be principally referred to the chief remote causes, excess in living, especially' excess in wine, being applied in a greater degree to the former. But, in addition to this circumstance, the-superior delicacy of the female structure and habit, puts some restraint on the acquirement of the inflammatory and plethoric state of vessels which appertains to gout. The actions of the uterus are not without effect in counteracting a general redundancy of blood." Hippocrates, says Dr. S., observes, in one of his aphorisms, <{ that gout seldom occurs in women till after menstruation lias ceasedbut we must remark a little want of correctness in the rendering of the aphorism in question, which merely asserts that females are not attacked with gout unless the menses be deficient, at least such is the sense which we have always been accustomed to attach to the verb externa, which is the word made use of in the aphorism referred to.
When, on the subject of predisposition, Dr. S. is naturally led to the question of the hereditary nature of gout; and, from his own observation, he concludes, that, although the malady is decidedly traceable in some instances from parent to progeny, yet that it is for the most part actually acquired without any hereditary tendency in the habit. "Dr. Adams (he says) has drawn a distinction which appears to me not very well founded, between the disposition and predisposition to disease. He attaches the strongest signification to the former of these expressions, (for they are only expressions,) a signification, which, as the word is compounded., is assuredly rather due to the latter. The epithets of strong and slight, in connection with either expression, would, I conceive, make the distinction sufficiently clear and marked, The author (Dr. A.) observes^ 1 if ft $02 Critical Analysis. it were true in all, as it is in most, cases, that ihc habits of the sedentary and healthy are necessary to induce the gouty action, there could be no question that it is only hereditary in predisposition ; but, in some, the susceptibility to gout is so strong as to require no other stimuli for inducing the action than such as seem absolutely necessary for the support of ordinary health.' In gout, therefore, we must admit the two degrees of susceptibility, disposition and predisposition, nor will it be often difficult to fix their exact limits. In his fundamental arrangement of the subject, the following view is offered. ' Diseases either appear at birth, in which case they are called congenital or connate, or they arise afterwards. The first can only with propriety be called hereditary, or family susceptibilities, to certain diseases.' This distinction of Dr. Adams's (continues Dr. S.) appears both judicious and necessary; but, probably, th6 reference in each case must be made to structure.
For myself I confess that I cannot form any satisfactory notion of hereditary quality that is not founded ou structure.'* Whatever tends to the production of vascular fullness, is regarded by Dr. S. as a predisposing eause of gout. <c In this country, (he adds,) and particularly in the metropolis, gout is much increased in frequency, among the lower stations of life, since the very general and free use of porter. This he considers a very nutritious fluid, and, in conjunction with spirits, even with a moderate quantity of solid food, may be viewed ai inducing the plethoric inflammatory state, and as a consequent introduction to gout. In Scotland, (our author continues,) gout is much more rare than in England. In Edinburgh, where the liabits of the people approach the nearest to those of London, it is found most; but it is scarcely ever known among the inferior classes. In two thousand two hundred cases of disease admitted into the Royal Infirmary, as clinical patients, under the care of Dr. Gregory, there were only two examples of gout. I also learn that Dr. Hamilton, in the course of thirty years' attendance at the Infirmary, has not seen more than two cases of gout. In the London hospitals, gout is rather frequent. In the abstract of diseases admitted at St. Thomas's Hospital, during ten ypars, under the care of Sir Gilbert Biane, in which the total number stated is 3813, the proportion of cases of gout is 130." We have already hinted that Dr. Seudamore is averse from those theories of gout which go upon the assumption of a specific matter diffused through the system as its immediate source.
The appearances which the urine of gouty subjects exhibits have been thought, even by some modern authors, to be in favour of this assumption ; but Dr. 8. affirms that the sediments which commonly occur in the urine of persons labouring under gout " are neither necessarily nor regularly attendant on a paroxysm of gout, and that they are found undev Br. Scudamore on Gout. 503 under other circumstances of disease, in connection with unhealthy chylopoietic functions. In proportion, therefore, as gout is connected with such disordered functions, and not further, are these jurinary evidences connected with that disease." An interesting passage follows on the component parts of urine. Dr. S. conceives that experimenters on the qualities and constituent parts of urine have been misled in not taking into account the different proportions of ingredients, according to the difference of its specific gravity. " An abundant deposit (he says) of gravelly crystals is not to be considered as a proof of an excess of uric acid, but rather as a separation of this principle from the urine, and a new combination with some other of its elements; and the deposition of the pink, or lateritious sediment (which is regarded, by our author, contrary to the opinion of Proust, as formed principally of the same ingredient with the gravelly cn^stals), is invariably connected with a high specific gravity of the urine. It seems to us, hoAvever, that the author, on this head, is rather disposed to strain a point in favour of his chylopoietic hypothesis; for Ave believe, that in two given quantities of urine, of precisely the same specific gravity, from two individuals, the one only a gouty subject, and, we would further add, from individuals who should be, as far as could be ascertained, in the same condition in reference to their digestive organs, the total quantity of uric acid would be found much to vary, as well as the relative quantity and combination of other ingredients. Neither would there be necessarily in both either the gravelly deposition or the lateritious sediment. Again, the particularly acid nature of the perspiration, under a paroxysm of the gout, is denied by our author, with somewhat, we conceive, too much of hypothetical strictness; for,allowing, with Berzelius, that " the matter of transpiration is always acid, and reddens litmus paper very distinctly," yet we believe this acidity to be, in some cases of gouty paroxysm, much increased. We are not, by any means, disposed to regard these excretory peculiarities as proofs of gouty matter, according to the theory of some; but may we not suspect our author somewhat tainted with that disposition to theory of which he accuses others.
He admits, in another place, that " gouty inflammation is an external evidence of a morbid condition of the system," and even opposes Mr. Hunter's more probable supposition " that the gout is not always an act of the constitution, but that parts may be so susceptible, or rather disposed for this actio;), that they immediately run into it when deranged." Surely then, according to his own admission, there is something more necessary to the production of a paroxysm than mere disturbance in the chylopoietic functions; otherwise, these disturbances and derangements, upon which it is so much the fashion to lay the whole stress of affairs, ought invariably, and without exception, to bring on gout.
" Ligament (continues Dr. S.) is probably the texture which is the most frequent scat of the gout; but the bursa; mucosas, the sheaths of tendons, and-the muscular aponeurosis, together with the respective vessels and nerves of these parts, may be also enumerated as textures primarily affected. Secondarily, the cellular membrane and skin share in the cffects of the inflammation. The textures just now mentioned, belonging to the functions of the joints, do not appear susceptible of the suppurative inflammation"? which is very unusual in gout. In one case which Dr.
Scudamore relates of gouty abscess, the suppurative process took place wholly in the common integuments.
The diagnosis, or discrimination of gout from rheumatism, erysipelas, and phlegmonis, is not, for the most part, attended with much difficulty : we shall pass on, therefore, tc> the prognosis, which is said to be favourable, " when the visceral organs are sound in structure, and not materially disturbed in their functions; when the tongue becomes moist and clean ; when there is a return of the natural appetite, the faces recovering a healthy character, the urine ceasing to deposit sediment, and at the same time losing its high specific gravity; when the nervous system becomes tranquil; and when the local sensations readily yield in their severity to remedies, the inflammation soon abating, and not shewing a disposition to quick transference from one part to another, or,'if it be fugitive, not fixing severely on new parts." These two last symptoms we conceive of the greatest importance for the practitioner to take cognizance of, when forming his judgment of the severity and probable obstinacy of the malady; and it is with pleasing; and unqualified approbation that we transcribe the following sentence of our author, bearing upon these points, which we arc heretical enough to suppose even more important to fix the attention than the state of the digestive functions. ment, upon the supposition of its being a salutary exercise of the vis medicatrix natura. He is not, however, a disciple of the Kinglake school, in regard to the fearless application jof local remedies. full claiai to our regard; but, when given in frequent doses, so as to excite mercurial fever, more or le6S of serious injury follows, as a certain consequence, without any corresponding advantages." Against the pretensions of specifics for gout, especially Against the claims of the Eau Medicinale, and other specifics, Dr. S. is very severe. He tells as, at the same time, that the alleged discoveries of the composition of this celebrated medicine are all fallacious. As this is a matter of much present interest, we shall transcribe the account which our author gives of his own experiments, in reference to the eau tnedicinale itself, and the several other compositions with Which it has been erroneously identified. u Eau Medicinale.?Colour and consistence similar to the extract of poppy; taste slightly bitter, and much resembling the extract of herbane; smell perfectly distinct from that of opium, and ?very similar to the common treacle lozenge; soon deliquesces after being dried. " Mixture of hellebore arid laudanum.?Colour and consistence similar to the eau medicinale; tastes strongly and smells slightly of opium ; soon deliquesces after being dried. " Tincture of Colchicum.?Colour lightly brown ; taste slightly, but distinctly bitter, and entirely different from that of the eau medicinale; smell, that of gum resin of guaiacum; soon deliquesces after being dried. " Tincture of Hedge Hyssop.?Colour almost black j taste very bitter, like Taraxacum ; no distinct comparable smell; dried and exposed in a damp apartment, very slowly and scarcely deliquesces." A detail of some serious and fatal consequences, which have followed the use of eau medicinale, concludes thus: 44 The usual bad results which the eau medicinale produces a very slightly balanced by the few examples in which it has given continued satisfaction; and, unless its composition should become known, and then receive some useful modifications from combination with other mcdicines, and from union with more ge-. neral principles of treatment, [ hope it will be entirely discarded from -the list of remedies in gout." In the opinion of Dr. Sciularnore, Peruvian bark and sudorifies may be, for the most part, superseded by purgative and sedative medicines: opium, judiciously employed, he strongly recommends; and, when idiosyncrasy prevents its full use, he has found henbane a useful substitute, " but it must be confessed, that, in severe pain, it is on opium alone thyt much dependauee can be placed." The active virtuesof the humulusL lupulus, recommended by Freake, appear to pur author " to be very questionable." v Alter these observations on the general treatment of gout* a consideration Dr. Scudamore on Gout. 507 a consideration of its local remedies follows. They have never, he affirms, been established upon fixed and regular principles. Leeches are considered as of doubtful propriety, and occasionally injurious. Vesicatories, irritants, warmth, and pediluvium, are all condemned, as well as the cold application of Dr. Kinglake, upon which we meet with some -severe animadversions. It is, however, allowedly necessary, while the attention is principally directed to constitutional requisitions, to allay the local irritation ; and Dr. S. proposes to accomplish this object by the employment of the following lotion, of which he has the satisfaction to state, he has made trial in about forty cases with the best success. " R. Alcoholis aviij. Misturte Camphora; ?xyj. M." This lotion is ordered to be made moderately warm, by the addition of some hot water, and kept constantly applied to the part inflamed. " The evaporation (says Dr. S.) which the alcohol alone would occasion, is advantageously restrained by this dilution; and the addition of a sufficient quantity of hot water is for the purpose of producing a temperature just agreeably lukewarm, and furnishes a prompt and convenient method of employing the lotion, on the principles on which I recommended its adoption. If it be applied either hot or cold, the intention of the remedy is frustrated; and I have observed, that, from being made too warm, its operation lias been injurious rather than beneficial. If the temperature is measured by the thermometer, I may state that it ought not to be less than 75, or more than 85. I consider, however, that the ex* pression of just agreeably lukewarm is a secure and sufficient direction to the patient. The linen compress, constantly kept wetted with the lotion, should consist of several folds, and the slightest and coolest covering only should be superincumbent." Several judicious instructions follow on the management of the convalescence : of these our limits will not permit us to give but a very slender abridgment, " It is not sufficient," observes Dr. S. " that our treatment has been active in the paroxysm : we have a great and two-fold duty remaining to be performed?the restoration of the healthy state of the digestive functions, and of due strength in the weakened limbs." The tincture of ammoniated iron, in such cases and circumstances as do not forbid the use of steel, from too much vascular fullness and action, " may be taken advantageously in warm water twice a-day, in doses of twenty drops, gradually increased to sixty ; joining with its use, as occasion requires, a suitable dose of the pulvis aloes compositus, formed into a pill with a decoction of the same and a little soap." General alteratives; moderation in diet; change Critical Analysis.' of air; the use of a circular roller, either of flannel or cotton, to cedematous limbs; and sponging the parts Avith tepid salt and water, with the occasional employment of a stimulant liniment, complete the catalogue of remedies recommended to assist the convalescence; subsequently to which our author details a series of instructive cases, in the relation of which he intermixes some valuable pathological observations. Through these, however, we have not space or leisure left to accompany him; nor can we find room for an analysis of his prophylactic rules of regimen, the general tenor and tendency of which may be easily inferred From what has already been advanced. His principles, of course, lead him to question the specific anti-arthritical properties of magnesia and the alkalies, respecting the former of which, he asserts, that it appears to him to be no further deserving of dependance than as an useful auxiliary to more active and comprehensive means.
Dr. Scudamore's formulae are, for the most part, neat and judicious; but not always so consistent with the principles of chemical union as we expected from a Avriter who has proved himself a considerable adept in chemical science. His language is easy, unaffected, and perspicuous; and the wrork, which must not be considered as an every-day pamphlet, may, notwithstanding a few theoretical peculiarities, be considered highly creditable to the talents and industry of its author. An appendix is attached to the body of the work, consisting of some judicious remarks on rheumatism; but, as we have already exceeded our limits, and, as the author promises to enlarge these hints into the form of a distinct treatise, we shall reserve our remarks till that design is accomplished.? A copious Index is subjoined to the whole, which much enhances the value of a book comprehending the opinions of so many writers who have preceded the author. Oracular Communications, addressed to Students of the Medical Profession. By JEsculapius. 12mo. pp.132. Cox and Son, 1816. This whimsical little performance is not destitute of merit and utility; but the whole might have been conveyed in a much less expensive form, and as well as much more compressed. The object is to direct a student in his medical education j and we heartily wish the emoluments of the profession would admit the expences here proposed. We cannot, however, see the necessity qf all of them ; parb ~ ticularly Ad-vice to Medical Students* 509 ticularly the journey to Scotland, we conceive, may be dispensed with, as the town which contains the Greatest number of inhabitants and the greatest number of hospitals, must exhibit the greatest number of cases, which, in a practical art, is what must be principally wanted. There may be, perhaps, less dissipation, and more habits of application, at Edinburgh; but these may be imitated iri London. In London, too, he will be less likely to fall into an error too common among the graduates in the north, and against which the Oracle particularly guards him.
{( Above all things, (says he,) let the student avoid becoming the slave of one system.
In whatever school of medicine he may be' educated, he willJind that only one range of doctrine is accounted orthodox: let him not adopt these only, as the basis of his medical creed: let him recollect, that other schools and other systems are alike built upon classical learning, indefatigable research, and just and solid reasoning,?and let him seek an acquaintance with these systems. This will enlarge his mind, and prevent his sinking at once into the common routine practitioner,?a consequence too often the inevitable result of his reception of one system, his belief of its dogmas, and the discredit he attaches to any valuable information, which may be found any where within the compass of medical science, except within the boundaries prescribed by his own bigotted and sectarian principles. This is a very common mistake; and, when the memory has been stored with these doctrines, the student fancies his knowledge is complete, and slumbers in inactivity, instead of pursuing after fresh and increasing information. Let him recollect that few men think perfectly alike on any subject, and let him seek to obtain an acquaintance with tho opinions and practice even of those who are excluded by the localities of nature from the little coterie, around which his contracted mind has described the circle of excellence, that he may enlarge his views, and, with the information he has acquired, be able to take a comprehensive survey of disease, and to judge of. truth for himself. And, to this end, let him gain all possible knowledge of continental medicine. All knowledge will be of use to him : and he should not despise any acquisition which will render him at all more fitted for the practice of his profession." In another place we meet with some judicious remarks on " continental medicine," as it is called. The author agrees with us, that, though their pathology is extremely deficient, yet, in description of disease, they are frequently more accurate than ourselves.
For those, however, who cannot afford to visit more than one seat of learning, we think it will not be disputed that in London there is less danger from the inevitable result of the reception of only one system, especially if the student follows the advice of one of our correspondents in attending two lecturers in medicine. [From our Correspondent in Germany.] Thilenius, the father, promised, in the second edition of his Medico-Chirurgical Remarks, 1809, to publish a second